Abstract
Introduction Expanding access to care has been shown to impact patient care and disease epidemiology
for different disease states, but has not been studied in pituitary adenoma. We hypothesize
that increasing access to care—which includes diagnostics—through the Affordable Care
Act (ACA) and Medicaid expansion has increased identification of pituitary adenomas.
Methods The National Cancer Institute's Surveillance, Epidemiology, and End Results database
was utilized to identify patients with pituitary adenomas from 2007–to 2016 yielding
39,120 cases. Demographic, histologic, and insurance data were extracted. After stratification
based on their insurance status, they were plotted to examine trends in insurance
status after introduction of the ACA and Medicaid expansion.
Magnetic resonance imaging (MRI) data was gathered from the Organization for Economic
Co-operation and Development. A linear regression model was developed to describe
the relationship between pituitary adenoma discovery and the number of MRI exams.
Results Pituitary adenoma diagnoses (37.6%) and MRI examinations per 1,000 in the U.S. (32.3%)
increased concurrently from 2007 to 2016. Linear regression analysis revealed a statistically
significant relationship (p = 0.0004). Those patients without insurance diagnosed with pituitary adenomas decreased
36.8% after Medicaid expansion (p = 0.023). With respect to Medicaid utilization, significant increases of 28.5% (p = 0.014) and 30.3% (p = 0.00096) were noted after both the ACA enactment and Medicaid expansion, respectively.
Conclusion The ACA has expanded health care access which has increased the ability to identify
patients with pituitary adenomas. The present study also provides evidence that access
to care is important for less prevalent diseases such as pituitary adenomas.
Keywords
pituitary adenoma - health care disparities - Affordable Care Act - MRI
